Division of Orthopaedic Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Spine (Phila Pa 1976). 2012 Jul 15;37(16):1407-14. doi: 10.1097/BRS.0b013e31824fffb9.
A retrospective comparative study.
To investigate the risk factors associated with upper instrumented vertebral (UIV) fractures in adult lumbar deformity.
Long segment lumbar fusions may lead to junctional failures. The purpose of this study was to determine factors associated with junctional failures.
Twenty-seven consecutive patients from 2001 to 2008 with minimum 4 levels fused, lower instrumented vertebra (LIV) of L5 or S1, upper instrumented vertebra of T10 or distal, and no previous surgery proximal to the instrumentation were retrospectively reviewed. We describe the UIV angle, the sagittal angle of the upper instrumented vertebra with the horizontal. Patients were divided into 3 groups: group 1, 7 patients with UIV fractures; group 2, 6 patients with other proximal failures; and group 3, 14 patients with no proximal complications.
The mean number of levels fused was 5.7 (4-7), 5.2 (4-8), and 6.2 (4-8); mean age was 64.1, 61.8, and 64.1, and mean body mass index was 33.5, 30.0, and 31.6 for groups 1, 2, and 3, respectively (P > 0.05). Osteotomies were performed in 5 of 7 in group 1, 1 of 6 in group 2, and 5 of 14 in group 3. Mean follow-up was 26.3 months. The average intraoperative UIV angle (UIV0) and immediate postoperative UIV angle (UIV1) were 18.6°/15.4° for group 1, 5.7°/5.3° for group 2, and 10.3°/7.1° for group 3 (P < 0.05). Surgical revision rates were higher in group 1 (71%) compared with groups 2 (50%) and 3 (43%). Eight of 11 (73%) patients with upper instrumented vertebra of L1 or L2 had either UIV fracture or other proximal failure compared with 5 of 16 (31%) in patients with upper instrumented vertebra of T10, T11, or T12.
Our series of long lumbar fusions had a high long-term complication and revision rate. A high UIV angle on intraoperative lateral radiograph was strongly associated with UIV fractures. UIVs of L1 or L2 had a higher rate of adjacent segment or UIV failure.
回顾性对比研究。
探讨与成人腰椎畸形相关的上节段固定椎体（UIV）骨折的危险因素。
长节段腰椎融合可能导致交界区失败。本研究的目的是确定与交界区失败相关的因素。
回顾性分析 2001 年至 2008 年间连续 27 例至少融合 4 个节段、下固定椎为 L5 或 S1、上固定椎为 T10 或其远端且近端无既往手术史的患者。我们描述了 UIV 角，即上固定椎与水平线的矢状角。将患者分为 3 组：第 1 组 7 例，UIV 骨折；第 2 组 6 例，其他近端失败；第 3 组 14 例，无近端并发症。
第 1、2、3 组的平均融合节段数分别为 5.7（4-7）、5.2（4-8）和 6.2（4-8）；平均年龄分别为 64.1、61.8 和 64.1；平均体重指数分别为 33.5、30.0 和 31.6。第 1 组中有 5 例、第 2 组中有 1 例、第 3 组中有 5 例行截骨术。平均随访时间为 26.3 个月。第 1 组的术中 UIV 角（UIV0）和术后即刻 UIV 角（UIV1）分别为 18.6°/15.4°，第 2 组为 5.7°/5.3°，第 3 组为 10.3°/7.1°（P<0.05）。第 1 组的手术翻修率（71%）高于第 2 组（50%）和第 3 组（43%）。11 例 UIV 为 L1 或 L2 的患者中，8 例（73%）出现 UIV 骨折或其他近端失败，而 UIV 为 T10、T11 或 T12 的 16 例患者中，仅 5 例（31%）出现相邻节段或 UIV 失败。
我们的长节段腰椎融合系列具有较高的长期并发症和翻修率。术中侧位 X 线片上 UIV 角度较高与 UIV 骨折密切相关。UIV 为 L1 或 L2 的患者相邻节段或 UIV 失败的发生率较高。
